Recurrent miscarriages and repeated implantation failures? Reproductive Centre Doctor: Please pay close attention to chronic endometritis!

Chronic endometritis is a chronic pelvic inflammatory disease, a chronic, benign condition with mild, atypical clinical symptoms that are easily overlooked. Dr chen points out that chronic endometritis is strongly associated with infertility, recurrent miscarriages, and repeated IVF implantation failures. Today, Dr Rona will share and explain about chronic endometritis.
　　What is endometritis?
　　Endometritis is a common gynaecological disease, mostly in conjunction with inflammation of the body of the uterus, and is divided into acute and chronic endometritis. Acute endometritis is characterised by infiltration of superficial endometrial epithelium and glandular neutrophils and formation of tiny abscesses, while chronic endometritis is characterised by oedema of the endometrial surface, high stromal cell density, asynchronous maturation of the epithelium and mesenchyme, and infiltration of endometrial mesenchymal plasma cells.
　　According to statistics, the incidence of chronic endometritis in infertile women can be up to 2.8-46%; in women with repeated implantation failure and recurrent miscarriage, the incidence can even be as high as 67.6% and 56.8% respectively. In the past, chronic endometritis was often overlooked by clinicians and patients due to its mild clinical symptoms and lack of specificity. In recent years, more and more studies have found that chronic endometritis may be associated with repeated implantation failure and recurrent miscarriage, which reduces the pregnancy rate of these women.
　　Clinical manifestations of chronic endometritis
　　Chronic endometritis often presents with asymptomatic or non-specific clinical features, such as pelvic pain, dysfunctional uterine bleeding, painful intercourse, recurrent cystitis, vaginitis, and mild abdominal discomfort.
　　What are the common causes of endometritis?
　　(1) Infection by microorganisms
　　Under normal circumstances, the endometrium has its own defence function, while endometritis is usually caused by childbirth or destroying the defence function and self-purification of the female reproductive tract, increasing the chances of pathogens infecting the reproductive tract and causing inflammation.
　　(2) Related to immune disorders
　　When chronic endometritis occurs, some cytokines (such as pro-inflammatory factors, chemokines, adhesion factors, etc.) are induced by microbial surface antigens of endometrial cells, thus causing abnormal endometrial immune responses, and it has been recently suggested that the number of plasma cells infiltrating the endometrial mesenchyme may be positively correlated with the severity of inflammation. In addition, subfamilies of multiple immunoglobulin IG classes are highly expressed in the oedematous stroma of chronic endometritis, and local immune responses mediated by antibodies to these immunoglobulins may adversely affect the embryo implantation process but rarely progress to a systemic inflammatory response.

What are the risk factors for the development of chronic endometritis?
　　(1) Prolonged placement of an intrauterine device (IUD), which can result in prolonged endometrial interstitial plasma cell infiltration even after removal of the IUD;
　　(2) History of multiple deliveries;
　　(3) Long duration of menstruation;
　　(4) Tubal obstruction.
　　(5) Irregular uterine bleeding.
　　(6) Others: history of previous miscarriages.
　　(7) In addition, vaginitis, endometriosis, endometrial hyperplasia, submucosal fibroids, endometrial tuberculosis, and endometrial osteomalacia have been found to be associated with chronic endometritis.
　　What are the adverse effects of chronic endometritis?
　　(1) Chronic endometritis can lead to increased risk of ectopic pregnancy: we all know that acute endometritis can cause ectopic pregnancy because endometritis can spread to the fallopian tubes, leading to salpingitis, causing the fallopian tubes to become incompetent or fall in peristaltic function of the fallopian tubes, which can lead to the occurrence of ectopic pregnancy. And chronic endometritis can also lead to ectopic pregnancy, the main reasons are:
　　A. Chronic endometritis is usually combined with inflammation of the fallopian tube or impaired function of the fallopian tube.
　　B. Chronic endometritis affects embryo implantation through a variety of mechanisms, forcing the fertilised egg to seek other implantation sites, including the fallopian tube.
　　(2) Detrimental to sperm-egg binding and embryo attachment and development: When chronic endometritis occurs, a number of cytokines and inflammatory mediators also cause sperm to become impaired and sperm-egg binding does not occur. Decreased sensitivity of the endometrium to ovarian sex hormone response, endometrial hyperplasia and secretion disorders, resulting in superficial endometrial erosion, ulceration and squamous epithelial hyperplasia, which are not conducive to the embryo’s implantation and development.
　　Daily precautions for endometritis patients
　　On top of active treatment, endometritis patients need to pay attention to hygiene in daily life, regular washing of the vulva, keep the vulva dry and clean, wear loose cotton pants, pants regular high temperature ironing or exposure to sunlight; both husband and wife wash before coitus; try to minimise unnecessary uterine operations; regular diet and life, combination of work and rest, keep in a happy mood to enhance their own immune system.
　　Chronic endometritis is one of the public enemies of women’s health.
　　It not only affects women’s physical and mental health.
　　It may also cause infertility, recurrent miscarriage and repeated implantation failure.
　　Therefore, this chronic disease should not be taken lightly.